| Capital Region Physicians - Southwest | |
|
1500 Southwest Blvd Ste D Jefferson City MO 65109 | |
| (573) 632-5780 | |
| (573) 632-5833 |
| Full Name | Capital Region Physicians - Southwest |
|---|---|
| Speciality | Family Medicine |
| Location | 1500 Southwest Blvd, Jefferson City, Missouri |
| Authorized Official Name and Position | Tom Luebbering (VP OF FINANCE) |
| Authorized Official Contact | 5736325100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Capital Region Physicians - Southwest 1500 Southwest Blvd Ste D Jefferson City MO 65109 Ph: (573) 632-5780 | Capital Region Physicians - Southwest 1500 Southwest Blvd Ste D Jefferson City MO 65109 Ph: (573) 632-5780 |
| NPI Number | 1124091285 |
|---|---|
| Provider Enumeration Date | 02/09/2006 |
| Last Update Date | 08/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124091285 | NPI | - | NPPES |
| 502474406 | Medicaid | MO | |
| CH7258 | Other | MO | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
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